Sexual and Reproductive Health Must Not Become the 'Cinderella' Service of the NHS, Says RCGP Chair

Years of improvement in the quality of sexual and reproductive healthcare being delivered to patients – including a halving of teenage pregnancy rates over the last decade and steadily increasing uptake rates of long acting reversible contraceptives (LARCs) – is at risk due to the bureaucratic, financial and training barriers facing GPs and practice teams, the Royal College of GPs is warning today.

Speaking at the Faculty of Sexual and Reproductive Health’s Annual Scientific Meeting Conference in Cardiff this afternoon, RCGP Chair Professor Helen Stokes-Lampard will highlight the findings of a College consultation with its 50,000-strong membership.

It found that GPs fear rates of teenage pregnancy and transmission of sexually transmitted diseases will rise – reversing current trends – as vulnerable patients are being excluded from accessing the most appropriate forms of contraception, and that health inequalities are being widened as a result.

Members particularly cited the difficulties patients living in rural areas have in accessing sexual and reproductive health services, as well as younger patients who rely on their parents for transport.

One respondent said: “Reduced numbers of specialist clinics has reduced access for our women, especially those who have cultural and social issues meaning they are unable to travel. Many GPs are feeing unsupported in their LARC fitting services and are giving up. And the young people's services are reduced as public health withdrew the funding to provide them.”

Professor Stokes-Lampard will call out the complex and fragmented way that sexual and reproductive health services are currently commissioned in England, as well as the decreasing services available in the community. As it stands, some services are commissioned by NHS England, others by Clinical Commissioning Groups, and yet others by Local Authorities, causing confusion amongst healthcare professionals and patients as to how to effectively navigate the system, and unacceptable variation across the country.

She will also highlight that the funding GP surgeries receive for providing patients with LARCs does not often cover costs, meaning that practices are making a loss for delivering this service as a time when general practice is already under intense financial strain.

Responding to the consultation, one member said: “We provide a weekly LARC drop in service at our practice but struggle with maintaining funding in practices rather than centrally. For our patients, services close to home are much better suited and this has become more of an issue since the city centre service closed only leaving a service on the other side of the city.”

Another concern raised in the paper, which Professor Stokes-Lampard will address today, is training – an issue that affects the whole of the UK. One respondent to the consultation, for example, said: “Many doctors providing LARC services in primary care are nearing retirement and access to training for their successors is a problem.”

Professor Stokes-Lampard will say: “In this day and age, all patients have the right to be provided with sufficient information to make the choice of contraception that is right for them, and be able to access that method without having to negotiate unnecessary hurdles – and GPs and our teams have the right to be properly trained and receive adequate recompense for carrying out these services.

“As one of the most cost-effective services we provide, sexual and reproductive health must not become the ‘Cinderella’ service of the NHS, especially when it has the potential to save the NHS millions through the prevention of unwanted pregnancies and transmission of STIs, as well as playing such as vital role in helping women control their fertility and therefore their lives.

“So much progress has been made in this area in recent years and the service is too important to be allowed to fall into decline.”

Further Information

As a result of the consultation, the RCGP Council paper made the following recommendations:

England:

Commissioners from CCGs, local authorities and NHS England should use the Better Care Fund to agree joint plans for SRH, with the aim of maximising choice and creating the best outcomes for patients, according to assessed local need;

Review the contracts and payment systems used to commission SRH and Genitourinary medicine (GUM) services so that they focus on integration, incentivising prevention and early intervention;

Introduce a public health indicator which measures the availability of LARC through GPs’ surgeries;

The Department of Health should give Public Health England responsibility for responding to the data collected around SRH, and mandate the organisation to make recommendations for action when outcomes decline;

Regulations should be amended to enable the introduction of statutory guidance on the number, type, and specifications of SRH services which local authorities must provide;

Introduce public health indicators which cover the whole care pathway for SRH and include over 25s;

The Department of Health should review the Framework for Sexual Health Improvement in England and establish an indicator set to monitor progress against it.

UK:

Specialist SRH services should meet the requirements of the Service Standards for Sexual and Reproductive Healthcare, outlined by the Faculty for Sexual and Reproductive Healthcare and equivalent standards should be developed for GUM services, drawing on sources such as the BASHH clinical guidelines;

Training for local GPs, medical students and nurses must be a mandatory part of specialist SRH services’ contracts;

Health Education England, The Northern Ireland Medical and Dental Training Agency, NHS Education for Scotland and Wales Deanery must work with Local education and training boards (LETBs) or deaneries to assess local need for training in SRH and the best way to meet it.

The Royal College of General Practitioners is a network of more than 52,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.